Documente Academic
Documente Profesional
Documente Cultură
Auscultation: Reduced breath sounds, bronchial breathing, crackles, increased fremitus, whisper pectoriloquy Percussion: dullness
Guidelines for Management A. Diagnosis Diagnosis of pneumonia requires 1. Evidence of consolidation on CXR 2. Plus one of: o Temperature >38 o Dyspnea o Chest pain o Cough B. Investigations Initial: Urgent CXR EUC, CBC SpO2 ABG (if sats <94%) Blood cultures If admitted: Sputum gram stain and cultures Sputum/nasal swab/throat swab for viral PCR Urinary Legionella antigen detection Pleurocentesis (if effusion) o pH, gram stain, culture, LDH, cell count Risk Stratification SMART-COP Systolic BP <90 (2 points) Multilobar CXR involvement Albumin <35 Respiratory rate Tachycardia Confusion Oxygen saturation (>50yo: <90%, <50yo, <93%) pH <7.35 C. Treatment If score 0-2: Consider outpatient treatment Amoxicillin + Doxycycline PO for 7 days If score 3-4: Admission Amoxycillin + Azithromycin + Gentamicin (in high risk groups) for 7-10 days If score 5-6: ICU admission If score 7+: Ventilator support Amoxycillin + Azithromycin + Gentamicin IV for 10 days If allergic to penicillin: use Cefuroxime for oral, Ceftriaxone for IV, Roxithromycin replaces doxycycline
Doxycycline/roxithromycin covers atypicals like mycoplasma and chlamydia If pneumococcus resistant, vancomycin and fluoroquinolones (moxifloxacin) are options If legionella positive in urine antigen test/culture, azithromycin is the drug